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Blaming the public for low swine flu vaccination rates is not fair, and not helpful

Dr Julie Leask, a Conjoint Senior Lecturer at the Sydney Medical School at the University of Sydney, writes:

A new report on the uptake of the swine flu vaccine shows what a few of us had predicted last year – that uptake would be low.

The AIHW report shows that only 1 in 5 Australians had the vaccine by February this year (21%). This is mainly because the public didn’t perceive swine flu as being serious (27%) or they were concerned about the vaccine’s safety (16%).

What is a little more surprising is that vaccine uptake only rose by 2 percent from last December’s 19%. So over the entire summer, very few extra people were getting the vaccine.

Despite this, 28% of those who hadn’t yet had the vaccine planned to do so. But it is unlikely all these people would actually do so, given what we know of other studies in this area.

Quite a few were probably waiting for the seasonal influenza vaccine to arrive (in March) and some GPs were advising that too.

Many would argue the low vaccine uptake was a perfectly reasonable response from the Australian public. Swine flu arrived with a big bang and went out with a sort of whimper. The vaccine arrived after a flu season seeing fewer deaths than many thought there might be. It wasn’t the big pandemic that the government had been planning for.

Of course if you ask intensive care staff, they will tell you a very different story – of unprecedented numbers of very sick pregnant women. This was certainly a flu affecting many more younger adults than seasonal flu does.

Then there were the issues around the swine flu vaccine itself summarised here. The AIWH survey respondents raised issues around the vaccine being “rushed and unsafe”; that “multi-dose vials are unsafe”; concernes about “potential side effects and fear of adverse event from vaccine.”

The survey reveals a few other interesting things. First that the over 65s were keenest (45% had the vaccine). Yet this group had the least likelihood of getting very sick from swine flu. Ultimately, they were probably just doing what they (should) do each year: having a flu vaccine. The behaviour is established, they are familiar with, and trust, flu vaccines. They were also more influenced by their doctor than younger people who were more focused on whether swine flu was serious enough to warrant getting vaccinated. It’s hard to tell whether this difference is simply because doctors tend to recommend flu vaccines to older people more or whether it’s a generational thing.

At the other end of the age spectrum, only 6% of kids under 4 (the age group most likely to spread the virus) were vaccinated. Parents were very likely to be distrustful of the ‘new’ vaccine for their kids. Some would have felt their fears vindicated when the seasonal flu vaccine was temporarily suspended due to an increase in febrile convulsions.

More women (23.2%) than men (18.7%) were having the vaccine and this probably just reflects their greater tendency to see doctors anyway. Interestingly, women were more worried about the vaccine’s safety than men who were preoccupied with its necessity.

Pregnant women, the group standing to benefit a lot from the vaccine, were less likely to have been vaccinated (19%) than non-pregnant women (23.4%).

It would be interesting to see GPs surveyed and find out just how many of them were recommending the vaccine. Some certainly were, but we know anecdotally that others were advising against it.

In vaccine uptake, doctors are extremely influential on vaccination behaviour. So a doctor’s recommendation is usually the single most important factor in vaccinating – or not.

That far more older people were having this vaccine – although younger adults and children stood to benefit the most – suggests that it’s about ingrained vaccination habits as much as anything.

We know that about 90% of children under 4 are vaccinated against the usual scheduled vaccines (measles, polio, whooping cough etc). When you compare this coverage to only 4% of kids having the influenza vaccine, it suggests that established habits and doctor recommendations were a key factor behind the AIHW findings.

With the way swine flu has played out in the public arena, it would be unfair to castigate the public for low uptake of its vaccine.

It would be better to ask how we can improve things next time: in communicating complex messages, dealing with uncertainty and involving all stakeholders.

If governments are keen on high vaccine uptake, then gauging doctors’ vaccination beliefs and recommendations and working closely with them is going to be just as important as focusing on the public.

• You can follow Julie Leask on Twitter if you are interested in staying in touch with vaccine-related and other public health news

Comments 3

  1. Fiona says:

    I didn’t get the swine flu only vaccine last year, I held out until I could get the seaonal one containing it this year. That was hat most people I know did.

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